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Publication The psychosis risk timeline: can we improve our preventive strategies? Part 1: early life(Cambridge University Press, 2019-06-21) Romain, Karen; Eriksson, Alexandra; Onyon, Richard; Kumar, Manoj; Coventry and Warwickshire Partnership NHS Trust; Midlands Partnership Foundation Trust; University of Keele; Psychiatry; Medical and Dental; Romain, Karen; Eriksson, Alexandra; Onyon, RichardPsychosis is a complex presentation with a wide range of factors contributing to its development, biological and environmental. Psychosis is a feature present in a variety of psychiatric disorders. It is important for clinicians to keep up to date with evidence regarding current understanding of the reasons psychosis may occur. Furthermore, it is necessary to find clinical utility from this knowledge so that effective primary, secondary and tertiary preventative strategies can be considered. This article is the first of a three-part series that examines contemporary knowledge of risk factors for psychosis and presents an overview of current explanations. The articles focus on the psychosis risk timeline, which gives a structure within which to consider key aspects of risk likely to affect people at different stages of life. In this first article, early life is discussed. It covers elements that contribute in the prenatal and early childhood period and includes genetic, nutritional and infective risk factors.Publication Dysglycaemia, Inflammation and Psychosis: Findings From the UK ALSPAC Birth Cohort(Oxford University Press, 2018-04-09) Perry, Benjamin Ian; Upthegrove, Rachel; Thompson, Andrew; Marwaha, Steven; Zammit, Stanley; Singh, Swaran Preet; Khandaker, Golam; Coventry and Warwickshire Partnership NHS Trust; University of Warwick; University of Birmingham; Birmingham and Solihull Mental Health Foundation Trust; University of Bristol; Cardiff University; University of Cambridge; National Institute for Health Research Cambridge Biomedical Research Centre; Cambridgeshire and Peterborough National Health Service Foundation Trust; Psychiatry; Medical and Dental; Perry, Benjamin Ian; Thompson, Andrew; Marwaha, Steven; Singh, Swaran PreetBackground: Psychosis is associated with both dysglycaemia and low-grade inflammation, but population-based studies investigating the interplay between these factors are scarce. Aims: (1) To explore the direction of association between markers of dysglycaemia, inflammation and psychotic experiences (PEs); and (2) To explore whether dysglycaemia moderates and/or mediates the association between inflammation and PEs. Method: Data from the Avon Longitudinal Study of Parents and Children (ALSPAC) birth cohort were modeled using logistic and linear regression to examine cross-sectional and longitudinal associations between markers of dysglycaemia (ages 9 and 18), interleukin-6 (IL-6) (age 9), and PEs (ages 12 and 18). We tested for an interaction between dysglycaemia and IL-6 on risk of PEs at age 18, and tested whether dysglycaemia mediated the relationship between IL-6 and PEs. Results: Based on 2627 participants, at age 18, insulin resistance (IR) was associated with PEs (adjusted OR = 2.32; 95% CI, 1.37-3.97). IR was associated with IL-6 both cross-sectionally and longitudinally. Interaction analyses under a multiplicative model showed that IR moderated the association between IL-6 at age 9 and PEs at age 18 (adjusted OR for interaction term = 2.18; 95% C.I., 1.06-4.49). Mediation analysis did not support a model of IR mediating the relationship between IL-6 and PEs. Implications: IR is associated with PEs in young people even before the onset of clinical psychosis. Metabolic alterations may interact with childhood inflammation to increase risk of PEs. The findings have implications for clinical practice and future research. Keywords: ALSPAC; dysglycaemia; inflammation; insulin resistance; psychosis; risk; schizophrenia.Publication QI 171 Improving Autism Spectrum Disorder (ASD) Support in the Early Intervention Team (EIT)(Coventry and Warwickshire Partnership NHS Trust, 2024) Collier, Karen; Singh, Sashriya; Supported by the Quality Improvement Team, Coventry and Warwickshire Partnership Trust; Coventry and Warwickshire Partnership NHS Trust; Early Intervention Team; Medical and Dental; Collier, Karen; Singh, SashriyaAim: To Improve the knowledge of early intervention team (South) regarding support and referral options for patients with suspected or confirmed autism spectrum disorder (ASD) The EI team has recently supported patients with either a new or existing diagnoses of ASD alongside their presentation of psychosis. An initial survey of the team showed there were areas where we could improve the teams knowledge. In particular of how to access referrals to key services and specific support and improving understanding of the role of different teams and services. Tools used: PDSA; Driver Diagram Project Impact: Overall an improvement in knowledge of services and referral processes was demonstrated in many areas. Results on re-assessment appeared more polarised with less “unsure” answers recorded. There has been some staff turnover during this period which may have also impacted on results. This is a specific area and although most staff will come across this at some stage it is not frequent for many team members. Further knowledge will come as they face this issue clinically and refer back to resources which have been developed or as further training opportunities arise. This initial screening work has resulted in some improvements but has also identified further areas future work can target more specifically.Publication Psychopathological outcomes of adolescent borderline personality disorder symptoms(Sage, 2019-10) Winsper, Catherine; Wolke, Dieter; Scott, Jan; Sharp, Carla; Thompson, Andrew; Marwaha, Steven; University of Warwick; Coventry and Warwickshire Partnership Trust; Newcastle University; University of Houston, Houston, TX, USA; Orygen, The Centre of Excellence in Youth Mental Health, Melbourne, VIC, Australia; Research and Innovation Department; Additional Professional Scientific and Technical Field; Winsper, CatherineObjective: Despite considerable morbidity and functional losses associated with adolescent borderline personality disorder, little is known about psychopathological outcomes. This study examined associations between adolescent borderline personality disorder symptoms and subsequent depressive, psychotic and hypomanic symptoms. Methods: We used data from the Avon Longitudinal Study of Parents and Children. Participants were adolescents living in the community who had data for all longitudinal outcomes (N = 1758). We used logistic regression and path analysis to investigate associations between borderline personality disorder (five or more probable/definite symptoms) reported at age 11–12 years and depressive and psychotic symptoms reported at age 12 and 18, and lifetime hypomanic symptoms reported at age 22–23 years. Results: Adolescent borderline personality disorder symptoms were associated with psychotic symptoms (odds ratio: 2.36, confidence interval: [1.82, 3.06]), diagnosis of depression at age 18 years (odds ratio: 1.30, confidence interval: [1.03, 1.64]) and hypomanic symptoms (odds ratio: 2.89, confidence interval: [2.40, 3.48]) at 22–23 years. Path analysis controlling for associations between all outcomes indicated that borderline personality disorder symptoms were independently associated with depressive symptoms (β = 0.97, p < 0.001) at 12 years and hypomanic (β = 0.58, p < 0.01) symptoms at 22–23 years. Borderline personality disorder symptoms were also associated with psychotic symptoms at age 12 years (β = 0.58, p < 0.01), which were linked (β = 0.34, p < 0.01) to psychotic symptoms at age 18 years. Conclusion: Adolescents with borderline personality disorder symptoms are at future risk of psychotic and hypomanic symptoms, and a diagnosis of depression. Future risk is independent of associations between psychopathological outcomes, indicating that adolescent borderline personality disorder symptoms have multifinal outcomes. Increasing awareness of borderline personality disorder in early adolescence could facilitate timely secondary prevention of these symptoms subsequently, helping to prevent future psychopathology.